Ice or Heat?

This is a good question that does not have a simple answer, because it depends.

It depends on what is causing your pain in the first place and it depends on what your goals are – pain management or faster healing?

Generally speaking there are two types of pain – acute pain and chronic pain.

Acute pain has a sudden onset and is often related to some type of trauma. It is easy to pin point when the pain started and how. It is usually related to a specific injury. The quality of the pain can be described as sharp. There is often redness, swelling and the area can be warm to the touch.

Chronic pain has usually been hanging around a while. It comes and goes. It builds in intensity over time. It can be dull and aching and it’s often hard to pin point when it actually started.

It is also common to have acute flare ups of a chronic condition.

Typically ice is recommended for managing acute pain and heat for chronic pain.

BUT…

Healing requires inflammation

When there is tissue damage in the body your immune system kicks in to repair it. Prostaglandins are released which causes vasodilation of blood vessels in the surrounding area.This increased blood flow to the injured area is called inflammation. Inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) which begin the repair process.

Anything that reduces inflammation has the potential to delay healing. Ice causes vasoconstriction of the blood vessels which means it narrows the vessel slowing down blood flow and reducing inflammation.

However, inflammation hurts and ice has been shown to reduce pain. For pain management you can cool an injured area by applying ice for a maximum of 10 minutes. Once the area has returned to temperature you can reapply the ice and repeat the process a few times.

So how exactly should you ice?

There are many ways to cool an injured area but here are a couple of suggestions:

Bag of ice – Fill a ziploc bag about half way with ice and add enough water to make it easier to mold the bag to the area you are icing.

Frozen gel packs – These are an easy and convenient option. Extra care should be taken when using gel packs as they are typically much colder than ice. It is a good idea to put an extra layer between the gel pack and your skin to avoid potential skin damage.

What about heat?

Heat vasodilates blood vessels making them wider and increasing blood flow. Heat will increase inflammation so do not apply heat if you suspect inflammation is present as it often is after a recent injury. Heat can be very soothing for tense muscles and stiff joints because it increases tissue elasticity.

My recommendation:

If you have injured yourself recently (in the last 24-48 hours), there is redness and swelling present and you are looking for pain relief, try ice. If the onset of pain was more than 48 hours ago and there is no obvious signs of inflammation do whatever feels better to you. If it increases symptoms or is uncomfortable discontinue use. Ask your practitioner what they would recommend for your specific situation. I often recommend a combination of both heat and cold but we can talk about that at your next appointment.